Based on NYS Department of Agriculture and Markets RA-113. Revised 7/2010 by Albany County
AGRICULTURAL DISTRICT REVIEW WORKSHEET
This form is to be completed by agricultural landowners whose lands are within an Agricultural District which is subject to a review or
landowners who wish to be added to the District. The information obtained from this form will be utilized by the County in determining the
significance and viability of agriculture within the District. Specific information collected is kept confidential. Data in this form may be saved and
printed or submitted electronically. More information on Agricultural District #3, including a map, is available at www.albanycounty.com/edcp
PART I - LANDOWNER DESCRIPTION
Name ______________________________________________ Telephone No. ________________________________
Mailing Address ________________________________________________State _____ Zip Code _________________
CHECK ONE
Farmer
Part-time Farmer
Non-Farmer
(If checked, please proceed
to Parts II and III)
(If checked, please proceed
to Parts II and III)
(If checked please
proceed to Part III C)
PART II - FARM DESCRIPTION
No. Acres Owned
No. Acres Cropped
No. Acres Rented (FROM another
landowner as part of farm)
Town Where Farmland is Located
Principal Farm Enterprise
(Check One)
____
Dairy
Other Farm Enterprise(s)
(Check One or More)
____
Dairy
Estimated Annual Gross Farm Sales
(Check one)
This information is optional
Cash Crop (Grain)
____
Cash Crop (Grain)
____
Below $10,000
____
Vegetables
____
Vegetable
____
$10,000 to $39,999
____
Orchard
____
Orchard
____
$40,000 to $99,999
____
Vineyard
____
Vineyard
____
$100,000 to $199,999
____
Livestock (other than dairy)
____
Livestock (other than dairy)
____
$200,000 to $499,999
____
Equine
____
Equine
____
Over $500,000
____
Poultry
____
Poultry
____
Horticulture Specialties
____
Horticulture Specialties
____
Sugarbush
____
Sugarbush
____
Christmas Tree
____
Christmas Tree
____
Hay
____
Hay
____
Apiary Products
____
Apiary Products
____
Other (specify below*)
____
Other (specify below*)
*
____
*
PART III - BOUNDARY DESCRIPTION
A. List tax map identification numbers for all parcels within the farm unit.
___________________ ____________________ ____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
B. List tax map ID numbers for all parcels rented FROM another landowner.
____________________ ____________________ ____________________
____________________
C. List tax map ID numbers for all parcels rented TO farmers.
____________________ ____________________ ____________________
____________________
D. List tax map ID numbers for new parcels to add to the District
____________________ ____________________ ____________________
____________________
E. List tax map ID numbers for parcels to remove from the District (i.e. no longer used for agriculture, developed, sold)
____________________ ____________________ ____________________ ____________________
(Attach additional sheets if necessary)